Adjunct Bone Marrow Injection in CABG Procedures

In a recent article, researchers evaluated whether autologous bone marrow-derived cells (BMCs) could improve residual, regional, stress-induced myocardial ischemia (SIMI) in patients with coronary artery disease (CAD) undergoing incomplete coronary artery bypass graft (CABG) surgery.

Based on their randomized controlled trial findings, the article’s authors suggested BMC appeared to further improve regional SIMI in patients with chronic ischemia when injected in sites not being directly surgically revascularized. Their data were presented in Frontiers in Cardiovascular Medicine.

This double-blind, randomized controlled trial enrolled 143 patients (82% male; median age, 58 ± 11 years) with stable CAD who were not eligible for complete CABG. The trial’s primary end point was improvement in SIMI based on area at risk in treated segments on cardiovascular magnetic resonance imaging at 1, 6, and 12 months post-CABG.

Bone Marrow Cells Improve CABG Myocardial Outcomes

A total of 77 participants received 100 million BMC and 66 received placebo injections at ischemic nonrevascularized segments during CABG. At 12 months after CABG, the reduction in global SIMI was comparable between the 2 groups (P=.0491); however, researchers noted additional improvements in regional SIMI among patients treated with BMC injections (P=.047).

Regional SIMI values for the BMC and placebo groups were 18.5 (95% CI, 16.2-21.0) and 18.5 (95% CI, 16.5-20.7) at baseline and reached the lowest values at 1 month at 9.74 (95% CI, 8.25-11.49) and 12.69 (95% CI, 10.84-14.85), respectively.

There was a 50% difference in regional SIMI at day 30 after CABG favoring the BMC-transplanted group. The authors theorized that BMC injections may improve microcirculation by “activating cardiac neoangiovasculogenesis and/or improving endothelial dysfunction.”

There were no significant differences in clinical or echocardiographic features between the groups during 12 months of follow-up, including left ventricular ejection fraction. There were also no significant differences in rates of major adverse cerebral and cardiovascular events (P=.34) or all-cause mortality (P=.08) at 1 month.

Ultimately, “these findings suggest that adult multipotent stem cell transplantation has a potential as an adjuvant therapy to complement flow restoration of ischemic myocardium,” the authors concluded.

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